Basic Information
| Provider Information | |||||||||
| NPI: | 1912053067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEDUC | ||||||||
| FirstName: | RANDALL | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593445552 | ||||||||
| Practice Location | |||||||||
| Address1: | 12930 NORTH STREET | ||||||||
| Address2: | |||||||||
| City: | DILLSBORO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124968783 | ||||||||
| FaxNumber: | 8124323384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01041214A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0401309 | 01 | IN | UNITED HEALTHCARE OF OHIO | OTHER | 5448484002 | 01 | IN | CIGNA | OTHER | 646524 | 01 | IN | AETNA | OTHER | 100094220 | 05 | IN | MEDICAID | 64011372 | 01 | IN | UNISYS | OTHER | 0401309 | 01 | IN | UNITED HEALTHCARE | OTHER | 64011372 | 05 | KY | MEDICAID | 000000031460 | 01 | IN | ANTHEM | OTHER | 1349998 | 01 | IN | FIRST HEALTH | OTHER | N41214 | 01 | IN | HUMANA | OTHER |